Texas requirements at a glance
| Check | Who needs it | When | Where to run it |
|---|---|---|---|
| Employee Misconduct Registry (EMR) | Every unlicensed applicant | Before hire or first client contact, then at least every 12 months | HHSC EMR/NAR search |
| Nurse Aide Registry (NAR) | Every unlicensed applicant | Same | HHSC EMR/NAR search |
| DPS criminal history (Health & Safety Code Ch. 250) | Every unlicensed applicant | Before hire or first client contact | Texas DPS secure site (name/DOB), or FACT fingerprinting where required |
| Out-of-state criminal history | Applicants who have lived outside Texas | Before hire | The other state's repository or a vendor; DPS covers Texas records only |
| OIG LEIE exclusion check | Agencies billing Medicaid or Medicare | At hire and monthly | HHS OIG |
The pre-hire rule: 26 TAC § 558.247
The HCSSA licensing rule requires three things before an unlicensed person is hired or has first face-to-face contact with a client, whichever comes first: a search of the NAR, a search of the EMR, and a criminal history check that complies with Chapter 250. The rule applies to every HCSSA license category: licensed home health, licensed and certified home health, hospice, and personal assistance services (PAS). A non-medical attendant is screened on exactly the same basis as a skilled aide.
"Unlicensed" is the operative word. RNs, LVNs, and therapists are screened through their own licensing boards; the § 558.247 process is for aides, attendants, and other staff who don't hold a professional license.
The Employee Misconduct Registry
The EMR (Health and Safety Code Chapter 253; 26 TAC Chapter 561) lists unlicensed staff with substantiated findings of abuse, neglect, exploitation, or misappropriation of a client's property, entered after an HHSC investigation and due-process period. A listing is permanent, and a HCSSA may not employ anyone on it in any capacity involving client contact. The EMR and NAR are searched together through the same HHSC lookup, which returns whether the person has a listing and, for aides, whether their certification is active.
Chapter 250 criminal history checks
Health and Safety Code Chapter 250 authorizes HCSSAs to obtain criminal history through the DPS secure site using a name and date of birth search (or through fingerprint-based FACT checks where HHSC requires them). Section 250.006 lists the convictions that bar employment:
- Permanent bars for offenses including murder, sexual assault, aggravated assault, injury to a child, elderly, or disabled individual, and certain other violent and sexual offenses.
- Five-year bars for a second group of offenses, counted from the date of conviction.
A DPS name-based search returns Texas records only. If an applicant has lived outside Texas, HHSC guidance directs the agency to obtain criminal history from the other state as well. Agencies that rely on the DPS result alone for a recent arrival are the ones that end up hiring someone with an out-of-state disqualifying conviction.
The 12-month re-check
For unlicensed employees with face-to-face client contact hired on or after September 1, 2009, the agency must re-search the NAR and EMR at least every 12 months. The criminal history check itself is not required to be repeated by the rule, but the registry searches are, and surveyors look for dated printouts in the personnel file showing the searches happened on schedule. Practical approach: set the re-check to the hire anniversary, or run the whole roster on a fixed month and document it.
Medicaid and Medicare providers: exclusion screening
If the agency bills Medicaid (including STAR+PLUS and waiver programs) or Medicare, it must also confirm that no employee or contractor appears on the HHS OIG List of Excluded Individuals/Entities, at hire and monthly. Payments connected to an excluded person are recoverable and carry civil monetary penalties. This is a federal overlay on top of the Texas checks, not a substitute for any of them.
Using a third-party screening vendor
A commercial background check vendor can run the DPS search and out-of-state searches for you, but the federal Fair Credit Reporting Act then applies: a standalone written disclosure, the applicant's written authorization, and a pre-adverse action notice (with a copy of the report and the FTC Summary of Rights) before you reject anyone based on it. A vendor report does not replace the EMR and NAR searches, which you run directly through HHSC.
Frequently asked questions
What is an EMR/NAR check?
A search of two Texas HHSC registries: the Employee Misconduct Registry, which lists unlicensed staff with substantiated abuse, neglect, exploitation, or misappropriation findings, and the Nurse Aide Registry, which shows aide certification status and any findings. Texas HCSSAs must search both before hiring an unlicensed worker and at least every 12 months after.
Do we have to fingerprint caregivers in Texas?
Chapter 250 checks for HCSSAs are typically name-and-date-of-birth searches through the DPS secure site. Fingerprint-based FACT checks apply where HHSC requires them; confirm the current requirement for your license category.
Can someone on the Employee Misconduct Registry ever be hired?
No. An EMR listing is permanent and bars employment by a HCSSA in any position involving client contact.
Does the annual re-check include a new criminal history search?
The rule requires the NAR and EMR searches to be repeated at least every 12 months. It does not require an annual criminal history re-check, though many agencies run one anyway.
A caregiver moved here from Louisiana last year. Is the DPS check enough?
No. DPS returns Texas records only. Obtain Louisiana criminal history as well before hire.
Do PAS (non-medical) agencies have the same requirements as home health?
Yes. § 558.247 applies to every HCSSA license category, including personal assistance services.
Not legal advice. Confirm details with the cited official sources or counsel. Full disclaimer
- https://oig.hhs.gov/exclusions/
- https://statutes.capitol.texas.gov/Docs/HS/htm/HS.250.htm
- https://www.ftc.gov/business-guidance/resources/background-checks-what-employers-need-know
- https://www.hhs.texas.gov/business/licensing-credentialing-regulation/long-term-care-credentialing/employee-misconduct-registry-emr
- https://www.hhs.texas.gov/providers/long-term-care-providers/home-community-support-services-agencies-hcssa
- https://www.hhs.texas.gov/providers/long-term-care-providers/home-community-support-services-agencies-hcssa/hcssa-statutes-rules
- https://www.law.cornell.edu/regulations/texas/26-Tex-Admin-Code-SS-558-247